Monitoring prioritisation in the public health-care sector by use of medical guidelines. The case of Norway

Askildsen, Jan Erik; Holmås, Tor Helge; Kaarboe, Oddvar

doi:10.1002/hec.1659

Cited by 23 publications

(16 citation statements)

References 15 publications

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“…9 Our rational for focusing on patients with a referral date between 1 January 2004 and 31 August 2004 is a change in the law of Patients' Rights introduced on 1 September 2004(Ministry of Health and Social Services, 1999, 2003). The law may have changed the prioritization practice of the hospitals Askildsen et al (2010Askildsen et al ( , 2011. andJanuleviciute et al (2010) analyzed the effects of the reform.…”

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confidence: 99%

Waiting Times and Socioeconomic Status. Evidence From Norway

Kaarboe

Carlsen

2013

Health Economics

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We investigate whether socioeconomic status, measured by income and education, affects waiting time when controls for severity and hospital-specific conditions are included. We also examine which aspects of the hospital supply (attachment to local hospital, traveling time, or choice of hospital) matter most for unequal treatment of different socioeconomic groups. The study uses administrative data from all elective inpatient and outpatient stays in somatic hospitals in Norway. The main results are that we find very little indication of discrimination with regard to income and education when both severity and aspects of hospital supply are controlled for. This result holds for both men and women.

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confidence: 99%

Waiting Times and Socioeconomic Status. Evidence From Norway

Kaarboe

Carlsen

2013

Health Economics

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“…19 Other studies -both Norwegian and international -have also found significant variations in waiting times and prioritization among different hospitals and specialties. [19][20][21] These indicate that it is difficult to develop priority-setting mechanisms that are precise and at the same time general enough. Other countries have introduced more formalized scoring systems for setting priorities between elective patients.…”

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confidence: 99%

Norwegian Priority Setting in Practice – an Analysis of Waiting Time Patterns Across Medical Disciplines

Gangstøe

Heggestad

Norheim

2016

Int J Health Policy Manag

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Background: Different strategies for addressing the challenge of prioritizing elective patients efficiently and fairly have been introduced in Norway. In the time period studied, there were three possible outcomes for elective patients that had been through the process of priority setting: (i) high priority with assigned individual maximum waiting time; (ii) low priority without a maximum waiting time; and (iii) refusal (not in need for specialized services). We study variation in priority status and waiting time of the first two groups across different medical disciplines. Methods: Data was extracted from the Norwegian Patient Register (NPR) and contains information on elective referrals to 41 hospitals in the Western Norway Regional Health Authority in 2010. The hospital practice across different specialties was measured by patient priority status and waiting times. The distributions of assigned maximum waiting times and the actual ones were analyzed using standard Kernel density estimation. The perspective of the planning process was studied by measuring the time interval between the actual start of healthcare and the maximum waiting time. Results: Considerable variation was found across medical specialties concerning proportion of priority patients and their maximum waiting times. The degree of differentiation in terms of maximum waiting times also varied by medical discipline. We found that the actual waiting time was very close to the assigned maximum waiting time. Furthermore, there was no clear correspondence between the actual waiting time for patients and their priority status. Conclusion: Variations across medical disciplines are often interpreted as differences in clinical judgment and capacity. Alternatively they primarily reflect differences in patient characteristics, patient case-mix, as well as capacity. One hypothesis for further research is that the introduction of maximum waiting times may have contributed to push the actual waiting time towards the maximum. The finding that the actual waiting time was very close to the maximum waiting time supports this. The lack of clear correspondence between the actual waiting time for patients and their priority status may imply that urgency, described in the referral letter, and severity of illness, according to guidelines, are two separate entities. Keywords: Waiting Lists, Prioritization, Healthcare Sector Copyright: © 2016 by Kerman University of Medical Sciences Citation: Gangstøe JJ, Heggestad T, Norheim OF. Norwegian priority setting in practice -an analysis of waiting time patterns across medical disciplines.

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“…They find that patients with the most severe conditions receive lower priority than recommended. The related study by Januleviciute et al (2013) also suggests that the introduction of such guidelines had no effect on improving waiting time prioritisation across four major severity groups; see also Askildsen et al (2010).…”

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confidence: 98%

Waiting time prioritisation: Evidence from England

Gutacker

Siciliani

Cookson

2016

Social Science & Medicine

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A number of OECD countries have introduced waiting time prioritisation policies which give explicit priority to severely ill patients with high marginal disutility of waiting. There is however little empirical evidence on how patients are actually prioritised. We exploit a unique opportunity to investigate this issue using a large national dataset with accurate measures of severity on nearly 400,000 patients. We link data from a national patient-reported outcome measures survey to administrative data on all patients waiting for a publicly funded hip and knee replacement in England during the years 2009-14. We find that patients suffering the most severe pain and immobility have shorter waits than those suffering the least, by about 24% for hip replacement and 11% for knee replacement, and that the association is approximately linear. These differentials are more closely associated with pain than immobility, and are larger in hospitals with longer average waiting times. These result suggests that doctors prioritise patients according to severity even when no formal prioritisation policy is in place and average waiting times are short.

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Monitoring prioritisation in the public health-care sector by use of medical guidelines. The case of Norway

Cited by 23 publications

References 15 publications

Waiting Times and Socioeconomic Status. Evidence From Norway

Waiting Times and Socioeconomic Status. Evidence From Norway

Norwegian Priority Setting in Practice – an Analysis of Waiting Time Patterns Across Medical Disciplines

Waiting time prioritisation: Evidence from England

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